Putri Annisa Kamila, Tara Hojjati, Nick S. Nurmohamed, Ibrahim Danad, Yipu Ding, Ruurt A. Jukema, Pieter G. Raijmakers, Roel S. Driessen, Michiel J. Bom, Pepijn van Diemen, Gianluca Pontone, Daniele Andreini, Hyuk-Jae Chang, Richard J. Katz, Andrew D. Choi, Paul Knaapen, Jeroen J. Bax, Alexander van Rosendael, Ran Heo, Hyung-Bok Park, Hugo Marques, Wijnand J. Stuijfzand, Jung Hyun Choi, Joon-Hyung Doh, Ae-Young Her, Bon-Kwon Koo, Chang-Wook Nam, Sang-Hoon Shin, Jason Cole, Alessia Gimelli, Muhammad Akram Khan, Bin Lu, Yang Gao, Faisal Nabi, Mouaz H. Al-Mallah, Ryo Nakazato, U. Joseph Schoepf, Randall C. Thompson, James J. Jang, Michael Ridner, Chris Rowan, Erick Avelar, Philippe Généreux, Guus A. de Waard
Background AI-QCTISCHEMIA is a novel artificial intelligence algorithm that predicts myocardial ischemia using quantitative features from coronary computed tomography angiography, providing a noninvasive alternative to functional imaging. However, its diagnostic performance across key demographic subgroups, particularly by sex and age, remains underexplored. We aimed to evaluate the diagnostic performance of AI-QCTISCHEMIA for predicting myocardial ischemia across these subgroups. Methods This post-hoc analysis included symptomatic patients with suspected coronary artery disease from the CREDENCE (Computed Tomographic Evaluation of Atherosclerotic Determinants of Myocardial Ischemia) (n = 305; 868 vessels) and PACIFIC-1 (Comparison of Coronary Computed Tomography Angiography, Single Photon Emission Computed Tomography [SPECT], Positron Emission Tomography [PET], and Hybrid Imaging for Diagnosis of Ischemic Heart Disease Determined by Fractional Flow Reserve) (n = 208; 612 vessels) studies. All patients underwent coronary computed tomography angiography, myocardial perfusion imaging (SPECT and/or PET), and invasive coronary angiography with 3-vessel fractional flow reserve as the reference standard. Diagnostic performance was evaluated at the vessel level using receiver operating characteristic analysis and under the curve (AUC), stratified by sex and age groups. Results In computed tomographic evaluation of atherosclerotic determinants of myocardial ischemia, AI-QCTISCHEMIA demonstrated higher diagnostic performance than myocardial perfusion imaging, with AUCs of 0.87 vs 0.63 in men and 0.85 vs 0.71 in women (P < .001 for both). Similarly, in older (≥65 years) and younger (<65 years) patients, AUCs were 0.85 vs 0.67 and 0.87 vs 0.63 (P < .001 for both). In PACIFIC-1, AI-QCTISCHEMIA outperformed SPECT in men (AUC = 0.86 vs 0.67; P < .001) and women (0.81 vs 0.65; P < .001) while performing comparably with PET (0.86 vs 0.82; P = .140; 0.81 vs 0.72; P = .214). In older patients, AI-QCTISCHEMIA showed higher performance than SPECT (0.85 vs 0.73; P < .001) and was similar to PET (0.85 vs 0.86; P = .816). In younger patients, it also outperformed SPECT (0.87 vs 0.66; P < .001) with comparable performance with PET (0.87 vs 0.84; P = .338). Conclusions AI-QCTISCHEMIA demonstrated consistently high diagnostic performance to detect myocardial ischemia across sex and age groups, significantly outperforming SPECT and showing comparable performance with PET, supporting its role as a noninvasive alternative for ischemia assessment. © 2025 The Author(s).
Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, South Korea; Division of Cardiology, Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, South Korea; Faculdade de Medicina da Universidade Católica Portuguesa, Lisboa, Portugal; Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Department of Cardiology, Pusan National University Hospital, Busan, South Korea; Division of Cardiology, Inje University Ilsan Paik Hospital, South Korea; Division of Cardiology, Department of Internal Medicine, Kangwon National University, College of Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea; Cardiovascular Center, Keimyung University Dongsan Hospital, Daegu, South Korea; Division of Cardiology, Department of Internal Medicine, Ewha Women's University Seoul Hospital, Seoul, South Korea; Mobile Cardiology Associates, Mobile, AL, United States; Department of Imaging, Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Cardiac Center of Texas, McKinney, TX, United States; State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China; Houston Methodist Hospital, Houston, TX, United States; Cardiovascular Center, St. Luke's International Hospital, Tokyo, Japan; Medical University of South Carolina, Charleston, SC, United States; Saint Luke's Mid America Heart Institute, Kansas, MO, United States; San Jose Medical Center, Kaiser Permanente, San Jose, CA, United States; University of Alabama-Birmingham, Birmingham, AL, United States; University of Wisconsin-Madison, Madison, WI, United States; Oconee Heart and Vascular Center, University of GA School of Medicine, Athens, GA, United States; Morristown Medical Center, Morristown, NJ, United States; Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands; Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia; The College of Liberal Arts and Sciences, Arizona State University, Tempe, AZ, United States; Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Department of Cardiology, Radboud University Medical Center, Nijmegen, Netherlands; School of Medicine, Nankai University, Tianjin, China; Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Department of University Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy; Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea; Division of Cardiology, The George Washington University School of Medicine, Washington, DC, United States; Turku University Hospital and University of Turku, Turku, Finland
